Re-engage Staff, Re-empower Patients

These are the 4 words that stood out to me from Lord Darzi’s review of the NHS. Just like all the doctors and nurses I know, we want to jump straight to the solution. If these 2 ideas are proposed as the answer, where did they come from. Before diving into problem solving, it is worth understanding the issues first.

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It seems there are also two key realities we must face up to. First is that we are getting sicker as a nation. We are sliding deeper into poor health, not looking after ourselves. We are expecting the NHS to be the rescue package, and it now can’t keep up. It is certainly trying, we have never offered more appointments, treatments or care packages, but despite this our markers of good health across all fields of care are deteriorating.

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Secondly, we have invested our resources and effort in the wrong part of the NHS. We have been drawn to the high cost, high profile hospital-based services. I think this is in part because we want to believe that sophisticated interventions will be more powerful and offer a better rescue. It takes the pressure of us, if we can just depend on tech. ?It is also driven by the high emotions of acute illness. When our loved ones are in crisis, with emergency problems like heart attacks, strokes, or mental breakdown we throw the book at them. Darzi shows we are good at this. But it doesn’t make sense. We have neglected investing in stopping people get to crisis point. As the metaphor goes, we are having to pull more people out the river downstream, because we are not stopping them falling in upstream.

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Both these realities mean we are expecting the NHS to work faster and harder to deal with a overwhelming flood of demand. It’s no wonder the staff are burnt out and disengaging. Its also why I understand Kier Starmer’s quote that the government won’t throw more money at the NHS, until we have changed our approach. “We won’t turn the taps on, until the plumbing is fixed”. If we keep doing more of the wrong thing, more money will only make it worse.

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As a GP who has practiced all my life believing in the power of empowering patients, this current rhetoric is music to my ears. I have long felt that the most effective health strategy is to focus on building people capability AND opportunity to look after themselves well. To me this requires a shift in our collective thinking, a re-examination of what we believe in, and expect from our NHS.

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It is a risky political narrative, because I think it involves asking more of people. We must ask people to contribute more, in looking after themselves, but also looking after each other. In the last few years, I have witnessed the impact of peer support in health. If we create the right (simple) opportunities people relish the chance to support each other. Its uplifting and empowering all-round to be part of a community that thrives under its own steam. Done well it creates as much wellbeing in the givers as the receivers. Its great value.

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It’s also risky, because it means pushing back against the commercial conditions that have contributed to our health-toxic environment. Not just the natural environment (which matters a lot) but the social environment too. The danger here is anyone standing up to the public health nightmare of ultra processed food and instant hit entertainment, is painted as the ‘Fun Police’. There is a hugely valuable set of industries that really don’t want us to be healthy, it’s much more profitable for us to be needy and sick.

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I finish this article with optimism. I see a government that sounds like it means business, and it prepared to use it’s majority to tackle the risky issues. I’m also optimistic because we know how to address these issues in the NHS. The last 5 years of driving ‘Personalised Care’, has shown how we can retrain staff and adopt new roles and approaches to achieve different outcomes. I have seen how enthusiastic health coaches and link workers can become when they are doing a job they love, that feels meaningful. I have seen how transformative it is for patients to club together in supporting each other.

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We have run some ‘tests of change’, it is now time to scale properly, build robust approaches on the back of pockets of excellence. It is not just about re-engaging staff and re-empowering patients. Its about going beyond that and re-engaging and re-empowering all of us. We can develop public capability and capacity to become a dynamic and active part of health creating communities. Not to be passive receivers, but active contributors. We all have a part to play in recharging our National Health.